罗哌卡因复合右美托咪定对臂丛神经阻滞的影响

Clinical efficacy of dexmedetomidine combined with ropivacaine in brachial plexus block

目的观察罗哌卡因复合右美托咪定对行喙突入路臂丛神经阻滞的影响。方法择期上肢手术患者60例,随机分成罗哌卡因组(R组)和右美托咪定复合罗哌卡因组(RD组),每组30例。患者在喙突内下2 cm处,在神经刺激器引导下给予药物,R、RD组分别给予罗哌卡因200 mg及罗哌卡因200 mg复合右美托咪定1 μg/kg,容量均为40 ml。记录患者手术侧臂丛感觉和运动阻滞起效时间、感觉和运动阻滞持续时间。记录患者给药前、给药后15、30、60、90、120 min的HR、SBP、DBP及SpO2。同时记录RD组给药前和给药后30 min非手术上肢的镇痛评分。记录两组患者不良反应发生情况。结果 R组感觉、运动阻滞起效时间明显长于RD组,感觉、运动的阻滞持续时间明显短于RD组(P<0.01);R组给药后30、60、90、120 min的HR明显快于、MAP明显高于RD组(P<0.05)。RD组给药前和给药后30 min非手术上肢的镇痛评分差异无统计学意义。RD组中有7例患者出现HR减慢,需要阿托品处理。结论罗哌卡因复合右美托咪定行臂丛神经阻滞可缩短臂丛神经的感觉、运动阻滞起效时间,延长感觉、运动阻滞持续时间。

Objective To investigate the clinical effect of dexmedetomidine combined with ropivacanie in brachial plexus block （BPB） through modified coracoid approach. Methods Sixty patients scheduled for selective upper extremity surgery were randomly divided into two groups, 30 patients in each group. BPB was performed at the point of 2 cm below coracoid directed by nerve stimulator. Ropivacaine （200 mg） was diluted into 40 ml in group R （n=30） and ropivacaine （200 mg）＋1μg/kg dexmedetomidine diluted into 40 ml in group RD （n= 30）. Motor and sensory block onset times and blockade durations were recorded. HR, SBP, DBP and SpO2 were recorded before drug administration and 15, 30, 60, 90 and 120 rain after drug administration. Visual Analog Scale （VAS） of normal upper extremity in group RD was recorded before drug administration and 30 min after drug administration. Side effects were recorded in both groups. Results Sensory and motor block onset time was sig nificantly longer in group R than those in group RD; Sensory and motor blockade durations in group R was significantly shorter than in those group RD （P〈0.01）. Compared with group RD, MAP, HR at 30, 60, 90, 120 minutes after drug administration were significantly higher in group R（P〈0.05）. VAS of normal upper extremity in group RD before drug administration and 30 min after drug administration had no statistical significance. 7 patients were treated with atropine for bradycardia in group RD. Conclusion Dexmedetomidine combined with ropivacaine for BPB shortens the sensory and motor block onset time and prolongs the duration of sensory and motor blockade.